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General NPI Number Information
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NPI Number | 1033160015
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Entity Type | Organization
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Legal Business Name | MONTICELLO DIAGNOSTIC IMAGING LP
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 3712 W 7TH ST
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City | FT WORTH
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State | TX
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Zip | 76107-2536
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Country | US
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Telephone | 817-377-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 7668 ELDORADO PKWY STE 200
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City | MCKINNEY
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State | TX
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Zip | 75070-5753
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Country | US
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Telephone | 817-377-3800
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Fax | 817-377-3801
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Authorized Official
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Title or Position | PRACTICE ADMIN
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Name | CHELSEA HOLDER
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Credential |
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Telephone | 817-377-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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